Origin and outbreak in China The first cases were reported in
Guizhou of southern
China, in 1956 or in early 1957. Observers within China noted an epidemic beginning in the third week of February in western Guizhou, between its capital
Guiyang and the city of
Qujing in neighbouring
Yunnan province. By the middle of March, the flu had spread all over China.), and did not inform other countries about the outbreak. The United States
CDC, however, contradicting most records, states that the flu was "first reported in
Singapore in February 1957". In late 1957, a second wave of the flu took place in
Northern China, especially in rural areas.
International spread (1957). On 17 April 1957,
The Times reported that "an influenza epidemic has affected thousands of
Hong Kong residents". The recent influx of about 700,000 refugees from mainland China had intensified authorities' fears of epidemics and fires due to crowded conditions, By the end of the month (or as early as February),
Singapore also experienced an outbreak of the new flu, which peaked in mid-May with 680 deaths. The only National Influenza Center reporting data to the World Health Organization for the southeast Asian region in 1957 was located in Singapore, and thus the country was the first to notify the WHO on 4 May about an extensive outbreak of the flu which "appeared to have been introduced from Hong Kong". In late June, the pandemic reached the
United Kingdom. By June 1957, it reached the
United States, where it initially caused few infections. Some of the first people affected were
US Navy personnel at destroyers docked at
Naval Station Newport and new military recruits elsewhere. The first wave peaked in October and affected mainly children who recently returned to school after summer break. The second wave, in January and February 1958, was more pronounced among elderly people and so was more fatal.
Eurasia Asia India The Government of India Influenza Centre in
Coonoor received word of the potential spread of the pandemic to India on 11 May and therefore decided to watch for the arrival of probable cases at
Calcutta and
Madras and to isolate the virus from such cases there. On 15 May, it was learned that the steamer S.S.
Rajula was experiencing an outbreak of influenza en route from Singapore and had been redirected to Madras instead of its first port of call in
Negapatam. Upon the ship's arrival on 16 May, 44 active cases of influenza were discovered on board, and the ship was accordingly placed in quarantine at sea and boarded by medical officers to examine and treat the sick. Two days later, four of the nurses who had boarded the ship became ill themselves, and thus the epidemic in India was considered to have begun.
Bombay reported its first cases on 21 May, and cases appeared in Calcutta that same week. Although the infections in Madras were considered the start of the outbreak in India, it is not clear whether Madras was indeed affected first and the other cities were infected as a result or whether all three cities were in fact affected independently of one another. It is likely they were infected independently but within just a few days of one another. Following the discharge of thousands of passengers from SS
Rajula on 21 May and SS
State of Madras on 28 May, the States of
Madras,
Mysore,
Kerala, and
Andhra apparently became heavily infected. Between 19 May 1957 and 8 February 1958, India reported 4,451,785 cases of influenza and 1,098 deaths, representing a
case fatality rate of 242 deaths per 1 million cases. However, at the beginning of May 1957, influenza suddenly broke out again, appearing first in Tokyo and
Kyoto Prefectures before spreading to other parts of the main island; by the end of May, the disease had spread all across the country. It was soon confirmed that this new outbreak was due to the novel influenza virus. The epidemic peaked in mid-June and then declined in the latter half of the month, remaining in only a few prefectures by the middle to end of July. Upon the reopening of schools in early September, the epidemic resurged, with scattered outbreaks appearing in primary and secondary schools in various localities. On 22 November, the epidemic was reported as having once again spread across the entire country, though it was considered "to be of limited importance", remaining as mild as it had been in the spring. By mid-December, over 1 million cases had been reported in school settings, and the outbreak had apparently passed its peak in most areas. There was another small peak in early 1958, though this could be considered merely a protraction of the second wave. with several Tokyo-area schools closing some of their classes due to outbreaks at the end of the month. The number of new cases had dropped dramatically, however, with 340 reported in 15 schools during the week ending 1 February, Japan was one of a few countries that experienced a widespread second wave of morbidity. It was found that areas less affected during the first wave ended up being more so during the second.
Turkey Pandemic influenza reached Iran, Iraq, and Syria in July 1957. Considering the extensive trade between Turkey and Syria and traffic between Turkey and Iran, it was clear that the virus would soon reach Turkey as well. Therefore, the
Ministry of Health and Social Welfare initiated the precautionary measures to deal with the passengers arriving in Turkey by air and sea and the
Mecca pilgrims arriving over land, sending two specialists at the end of July to observe the situation in the cities in the southeast and to take throat swabs and washings and serum samples for examination. Influenza infections were thus discovered within the civilian population and police and military units. Cases were detected in
Erzurum and
Ankara during the first week of August, and by the following week, cases were being reported from almost every part of the country. Given that schools were on holiday and the agricultural population was in the fields at this time, epidemic influenza was observed only in the larger cities and among factory workers, military units, and other concentrated communities during August and September. Once schools opened in October, however, cases began to appear among the students and the disease spread rapidly. Schools soon had to be closed again because 25–30% of students were absent due to illness. The epidemic peaked that same month and then declined through April 1958.
East Germany The pandemic broke out in
East Germany in October 1957 and peaked that same month. After a month of quiescence, there was a recurrence of the epidemic before it finally ended in December.
Netherlands Pandemic influenza first appeared in the
Netherlands in June 1957. Between June and August, sporadic cases occurred as a result of laboratory infection, a visit to an airfield, and introductions from Indonesia, Turkey, England, and Rome and the Near East. The first focus was a school in
Bussum, which had no known link with Asia but where the first cases nonetheless appeared on 14 June.
Rotterdam was likely another initial focus, as cases appeared there at the end of June in at least three schools. Subsequently to these outbreaks, influenza appeared in several boarding schools and other institutions in Bussum and Rotterdam and in other towns and villages in the vicinity. Foci continued to appear in August, though no widespread epidemics developed yet during this time. The true nationwide outbreak of influenza began during the period 20 August to 7 September. After boarding schools reopened at the start of September, seeding of the virus became more extensive, and the disease broke out in several of the schools. The first wave lasted about two months, but the disease continued to spread for some time thereafter.
United Kingdom The first reported case of pandemic influenza in the United Kingdom occurred on 6 June 1957, via importation, while the first outbreak was recognized in London on 17 June 1957 in Pakistani seamen who had arrived in the country by air on the 13th. Localized outbreaks of the disease developed over the summer, from mid-June to mid-August, while importations of the virus continued throughout July and August. The first indigenous case of influenza was noted on 28 June. Beginning in early July, outbreaks occurred among troops returning from affected areas in the East. outbreaks immediately developed among them beginning 10 July. As in the United States, the cause of this recrudescence is not entirely clear, though older people seemed to be more affected. All-cause excess mortality totaled about 30,000 with 14,000 A second wave of morbidity began towards the end of September and the start of October, when influenza now increased throughout the entire country. Although the disease was more widespread than it had been in the spring, it was observed that those cities more seriously affected in the spring were more moderately affected in the autumn. The epidemic peaked in the latter half of October and then began to decrease in early November before falling back to unusual interepidemic levels in December, though morbidity remained slightly elevated during the first four months of 1958. Nationally, Canada did not experience a widespread second wave of mortality, as the United States did. However, a second wave was observed in
Quebec and in particular
Montreal, where all-cause excess mortality in the winter of 1958 exceeded that incurred during the first wave in the fall. Among other activities, the Board maintained surveillance of influenza-like illness around the world, operating 176 stations by 1957. The Commission on Influenza also conducted studies into vaccination, which was considered "the only really effective control measure available in combating influenza".
National response The notion that an influenza pandemic was developing in the Far East first occurred to American microbiologist
Maurice Hilleman, who was alarmed by pictures of those affected by the virus in Hong Kong that were published in
The New York Times, on 17 April 1957. and, on 12 May, the first isolate was sent out to the vaccine manufacturers as soon as they all arrived in the US. The Office of the Surgeon General became aware of the situation in Asia on 20 May. The Surgeon General,
Leroy E. Burney, was out of the country at the time, representing the US at the Tenth
World Health Assembly in
Geneva. The Deputy Surgeon General, W. Palmer Dearing, therefore spread the word and established special liaison with the
National Institutes of Health on Burney's behalf. Hilleman predicted an epidemic would strike the US when schools reopened in the fall. All Epidemic Intelligence Service officers and all relevant personnel at the CDC were alerted of the priority of investigating cases and outbreaks of influenza-like disease at that time. The Public Health Service formally began its participation in the national effort against the flu on 28 May. The Surgeons General of the military called a meeting with the Service to discuss the control of the novel influenza. The disease was noted for its mild presentation though high rates of attack in various settings. It was the opinion of those at the meeting that the virus was already in the US, but no epidemic was expected until the fall. It was recommended that the
Department of Defense purchase about 3 million doses of monovalent vaccine targeting the pandemic virus. The Commission on Influenza was asked to propose the composition of the polyvalent vaccine to be used as well. On 27 June, NIH reported its plans for influenza research that would take advantage of the unique opportunity that was the pandemic. These included clinical studies of those afflicted with the disease, with emphasis on potential cardiovascular and systemic effects; studies of the factors contributing to increased mortality among elderly and debilitated patients; and studies of the disease among vaccinated communities. On 3 July, the director of the
National Institute of Allergy and Infectious Diseases,
Justin M. Andrews, was designated the "focal point" at NIH for flu-related matters. A week later, Burney testified before the
Senate Appropriations Committee to discuss this request. It provided a total of $800,000 in additional PHS funds to go towards the production and distribution of tests, surveillance and laboratory services, data collection and dissemination, and public health education. Two hundred and seventy-five thousand dollars previously appropriated for communicable disease control was authorized for transfer to flu-related activities, and a further $2 million of emergency funds was made available to the president for transfer. On 22 May, the naval destroyer
USS Barry arrived at Naval Station Newport, in Rhode Island, having spent no time in Far East waters at all. A total of 391 high-school girls from all across the state traveled to Davis via chartered buses and arrived on 17 June. The next day, two came down with illness. Subsequently, until 25 June, 224 girls and four adult staff members became ill but experienced generally mild symptoms, with only two suffering minimal complications. Virus isolations revealed the infections to be pandemic influenza. On 26 June, a Westminster Fellowship Conference convened at
Grinnell College in Iowa, bringing together 1,688 delegates from 43 states and 10 countries. Vice President
Richard Nixon was the guest of honor at the pageant, the Valley Forge Story, and country music singer
Jimmy Dean provided entertainment. There was some evidence of influenza among Scouts from California, Louisiana, and
Puerto Rico, as many fell ill en route to the Jamboree. Nonetheless, in the days following the Jamboree, a number of outbreaks appeared among Scout groups returning from the event, and cases were subsequently reported from various states including Louisiana, Connecticut, Massachusetts, South Carolina, Virginia, Wyoming, Montana, and Texas. In August, sporadic cases of influenza continued to appear. In the early part of the month, the first major community-wide outbreak occurred in
Tangipahoa Parish, Louisiana. This outbreak was clearly associated with the opening of summer school sessions in that parish. The first major urban outbreak appeared in
New Orleans shortly thereafter. When several Mississippi counties also experienced community outbreaks upon the reopening of schools in mid-August, it became clear that a nationwide epidemic was all but certain to occur with the general opening of public schools. By the end of the month, influenza had been reported from at least 197 counties (over the course of 18 weeks), at least 16 of which across seven states had apparently experienced community-wide outbreaks. By the end of the following week, 88 new counties had reported the appearance of influenza. By the end of October, nearly every state was reporting influenza outbreaks in 50% of their counties. He shared the findings of the US National Health Survey, which found that, between 1 July and 1 December 1957, over 80 million Americans—or about half the country—suffered from upper respiratory illness so severe that they had to spend one or more days in bed. Though not all cases could be attributed to pandemic influenza, he considered it reasonable to suppose that it accounted for most of the illnesses. Although pandemic influenza was still occurring sporadically, no widespread outbreaks were being reported. The cause of this increase in mortality, therefore, was not clear. It is not clear what caused the increased mortality in the early months of 1958, though various explanations were suggested. Burney speculated that these deaths might have been "the result of weakening effects of earlier 'flu' attacks upon older persons" with underlying conditions or other respiratory infections, while the CDC suggested that these individuals might have evaded infection during the fall epidemic altogether due to their more secluded lifestyles but were now being affected. Another hypothesis was that the deaths were the result of staphylococcal pneumonia, as a number of deaths had been caused by that infection in the fall. Mortality data and information from hospital centers, however, did not support this. The cause of this "second wave" of mortality therefore remains a mystery. excess deaths occurred in the United States during the entire epidemic period from October 1957 to March 1958. In recognition of the worldwide threat of epidemic influenza, the WHO launched its
Global Influenza Programme in 1947 with the establishment of the World Influenza Centre at the
National Institute for Medical Research in
London. This eventually gave rise to the Global Influenza Surveillance Network in 1952 to facilitate global scientific collaboration and fulfil the objectives of the programme. In 1957, China was not a member of the WHO, and thus it was not a part of its influenza surveillance network. Therefore, it took several weeks, if not months, for the news of an outbreak to reach the WHO, when the virus had already spread into Hong Kong and then to Singapore. This fact would be lamented repeatedly after the pandemic, and it was taken as reinforcement of the importance of a "truly worldwide" network of epidemiological surveillance. Following this delay, things then "moved swiftly". This information was first reported in the
Weekly Epidemiological Record for 29 May. The need for a single, consistent name for the novel virus became clear as it continued to spread and became more commonly discussed. Up to this point, the causative agent had mostly been called "Far East influenza virus" or "Far East strain (influenza virus)" or even "Oriental flu", though "Asian influenza" had been used before. On 11 July, the question was finally taken up at an informal meeting of scientists during the Fourth International Poliomyelitis Congress in Geneva. There it was agreed that "Asian influenza" was a "descriptive and appropriate" name for the "contemporary manifestation of the ancient disease", On 23 July, the WHO issued a circular letter advising that surplus vaccine be made available to poorer countries at the "lowest economic price". It is not clear if the UN or the WHO ever responded to Tepsix's letter. However, US Surgeon General Leroy E. Burney would later dismiss this notion on 26 August in response to a similar question raised by the press. On 11 October, the WHO announced that the virus had spread to all populated parts of the world aside from "a few islands or territories having no contact with the outside world". Following the main phase of the pandemic in 1957, the WHO reflected on its performance as part of its review of the first ten years of the organization in 1958. It concluded that "the WHO influenza programme fulfilled the major task allotted to it", which allowed "many parts of the world to organize health services to meet the threat and for some countries to attempt to protect priority groups by vaccination". However, it acknowledged that had its influenza surveillance network been "truly worldwide", as it would repeatedly lament it was not, then preparations could have begun two months earlier. Similar studies into their efficacy and safety continued until 1945, when the first inactivated virus vaccine entered the market for commercial use. In the fall of that year and the spring of 1946, the entirety of the Armed Forces received the inactivated virus vaccine. During the winter of 1946–1947, a worldwide influenza epidemic occurred, an event that for some time was itself considered a pandemic due to its global distribution albeit low mortality. Vaccines that had been effective during the 1943–1944 and 1944–1945 seasons suddenly failed during this epidemic. It was found that the influenza A virus had undergone significant
antigenic drift, resulting in a virus that was quite antigenically distinct, but not one of an entirely new subtype. This experience demonstrated the necessity to alter vaccine composition to match newly circulating strains. In the winter of 1950–1951, a severe influenza epidemic ravaged England and Wales, the number of weekly deaths at one point even surpassing that of the 1918 pandemic in
Liverpool. Public health experts in the US, fearing the implications of the outbreak on their country, decided to impose a challenge on themselves: to see how quickly the British virus could be imported into the US, its antigenic structure analyzed, and then incorporated into a new vaccine, if the virus were found to be distinct from preexisting strains. Upon receipt of the strains at the laboratories at Walter Reed Army Institute of Research and the National Institute of Allergy and Infectious Diseases, which then sent samples to the vaccine manufacturers, the two government laboratories were able to produce the required 1 liter of vaccine of "acceptable potency, sterility, and safety" in three weeks; the manufacturers were soon to follow. The exercise was considered a success by those involved, but it was recognized that a repeat performance in the future might not be so likely without the same factors in their favor. Out of this exercise came a list of recommended priority groups from the civilian occupational population to be inoculated in the event of an emergency. Before the middle of June, the first experimental lots had been produced and promptly entered into testing at the National Institutes of Health, which was expected to take about two weeks. On 20 June, an associate director of NIH laid out various alternatives for the course of the virus in the US and how to respond to each: an explosive outbreak before 1 September, with either continued low mortality or increased virulence (vaccination would not be possible, except for the use of limited polyvalent vaccine supplies and possible use in 1958); sporadic local activity during the summer with an explosive outbreak in the winter, again with low mortality (vaccinate priority groups) or increased virulence (maximize vaccine production, vaccination would be required, and priority groups would receive it first); or sporadic local activity during the summer with normal incidence in the winter (no recommendation of vaccination). It was generally agreed that the most likely outcome would be closer to the second possibility, with sporadic local activity during the summer with an epidemic in the fall or winter, with little increase in lethality. It was also clear then that the quantities of vaccine necessary for large-scale inoculation would not be ready until after the middle of August, but if the epidemic held off until the fall and winter, as was considered likely, it would be possible protect a significant part of the population. This framework was later presented to the Secretary of Health, Education, and Welfare on 24 June. In 1957, six pharmaceutical companies were licensed to manufacture influenza vaccine: Merck Sharpe & Dohme,
Eli Lilly & Co.,
Parke, Davis & Co., Pitman-Moore Co., National Drug Company, and
Lederle Laboratories. As members of the pharmaceutical industry, they had participated in the effort since the day the Public Health Service sent them samples of the virus. Maurice Hilleman happened to be close to the industry, and he helped secure the initial involvement of the manufacturers, going to them directly to spur development and avoiding "the bureaucratic red tape" that might typically forestall manufacture of new pharmaceutical products. the Department of Defense provided a significant stimulus to commercial production by placing an order for 2,650,000 ml of monovalent vaccine. were sent to NIH in early July. By this time, Pitman-Moore had received a government contract for about half a million doses while Eli Lilly had not, though Lilly confirmed it would be moving ahead with production on a "preparedness basis". Service officials that day also met with the executive committee of the Association of State and Territorial Health Officers in Washington, D.C., where the flu situation was discussed. The officers agreed with the proposed PHS–AMA partnership to launch a public health education campaign, specifically one that urged vaccination against the flu. At this time, influenza vaccines had generally been used by large companies to protect their employees, but with the threat of a probable, large-scale outbreak, stimulating their broader use seemed advisable. It was made clear that there would not be enough time to produce enough vaccine to inoculate a majority of the country before the flu season, but vaccination, as "the only known preventive" against the flu, was viewed as the best course of action. When asked about the potential for mass immunization programs like those against polio, Burney stated that these would be the states' responsibility, but he conceded that "you could probably get more immunized in a shorter period" that way. The principal reason against such a policy was, apparently, that "that isn't the ordinary way we do things in this country." On 2 August, representatives of the Armed Forces, the
Veterans Administration, and PHS met to discuss the question of vaccine dosage. It was the opinion of the Office of the Surgeon General, upon review of studies thus far reported, that 1 cc (cubic centimeter) of monovalent vaccine, with a strength of 200 CCA units, would be "the most effective and practical dosage". This potency was selected in light of difficulties during the early-summer trials in obtaining high yields of the virus in embryonated eggs, with any strength greater than 200 CCA seeming unlikely. On 12 August, Burney sent individual letters to each of the manufacturers requesting their cooperation with PHS in a "voluntary system of equitable interstate allocations" of the pandemic vaccine while supplies remained limited. They all agreed. The first lot of 502,000 doses of vaccines was released on 12 August. Nonetheless,
Time reported that National Drug Co. and Lederle Laboratories had sent their initial doses to companies across the country, leaving it to them to distribute the shots, and that indeed individual doctors had begun vaccinating "favored patients". At the same time, the
NFL's
Chicago Cardinals were able to announce that the entire team would be vaccinated against the flu. The pandemic vaccine became relevant for the
Eisenhower administration not long after the first doses were released.
White House Press Secretary James Hagerty would report that two doses had been sent to
Secretary of the Interior Fred A. Seaton by PHS. However, Seaton decided beginning his inoculation was not necessary before his trip to Hawaii. On 21 August, a spokesperson for the
Department of Agriculture had to deny the speculation that the use of millions of eggs necessary for vaccine production would "skyrocket" the price of eggs. That same day, President Eisenhower was asked whether he would receive the pandemic vaccine. He replied, "I am going to take it just as soon as ordinary people like I am can get it." Eisenhower later met with his chief economic advisor,
Gabriel Hauge. On 22 August, Hauge was sent home ill. That same day, Burney stated that the president was "an essential person" and should get vaccinated immediately, a recommendation with which Eisenhower's personal physician, Major General
Howard McCrum Snyder, "agreed completely". On 24 August, Burney made the pointed recommendation that those with a history of heart or lung conditions be vaccinated early. Finally, based on Burney's recommendation the preceding weekend, The second lot of 562,610 doses was released on 28 August, bringing the total to 1,149,610 doses for both military and civilian use. Burney shared the expectation that, based on the current pace of production, it was possible that 80 to 85 million doses would be ready by 1 January, 20 million doses more and one month sooner than originally anticipated. The Armed Forces announced their intention to give two injections to each servicemember, and thus their order had increased from 4 million doses to over 7 million. Just as after release of the first batch of vaccine, issues with supply and allocation quickly became apparent yet again. Although authorities like the
New York County Medical Society and wholesalers in Washington, D.C., made clear that vaccine would not be available for the public until September or even October, there was still intense demand for the vaccine. A physician's secretary in the district reported in
The Evening Star that her office was receiving "dozens" of calls every day from anxious patients. This was not helped by Burney's statement days before, that there was sufficient vaccine in the district to vaccinate those with heart and lung conditions, such as the president. Even the
State Department had not received any vaccine, and it was reportedly unknown when it would. One district physician decried this state of affairs as "grossly unfair"; However, the company defended its distribution practices by asserting it was "trying to get as much of the vaccine out as possible." Others echoed this call for some "special action of one vague kind or another" by the federal government, just as had been advocated for during the early days of the Salk vaccine. On 4 September, PHS officially announced the system of allocation agreed to by the manufacturers, which would allocate vaccine supplies to states in proportion to their population, though it made clear that the program would not retroactively apply to any allotments of vaccine already shipped to fill military or civilian orders. The Service also emphatically reiterated that the allocation plan was "strictly voluntary". On 5 September, the week-long eighth session of the Regional Committee for the Western Pacific of the World Health Organization commenced in Hong Kong. Burney, the elected vice chairman for the session, gave a progress report on the pandemic response in the United States, including the vaccine situation, in which he stated his expectation that 85 million doses would be ready in order to combat the epidemic. That same day, PHS announced the release of a further 1,028,295 doses, entirely for civilian use, in addition to the 3,705,770 doses already released. As the vaccine began to be rolled out "in quantity", so too did the nationwide incidence of influenza begin to rise with the reopening of schools. On 18 September, PHS reported that vaccine production had fallen short of the original expectation of 8 million doses by the middle of the month, with only 5,430,442 having been released by that point. The release of another 1,526,590 doses that week, however, brought the total to 6,957,032. Despite this shortfall, the Service estimated that 12.2 million doses would still be produced by the end of September. This goal proved feasible as production increased, and a total of 13,504,947 doses were ultimately released through 1 October. Although vaccine was, at this point, being rolled out at a faster pace than expected, the issue of exact allocation persisted. On 7 October,
Time reported that most supplies had seemingly "been sold to anyone who went after [the vaccine] early and energetically"; this included, in particular, "football teams and business concerns." As a result, the
San Francisco 49ers and the football teams of
Stanford and the
University of California had received inoculations, as had employees of
Dun & Bradstreet and the Retail Credit Co. (today
Equifax); many essential workers in at least a dozen cities, on the other hand, received none. The agreement between PHS and the manufacturers on a "voluntary" system of allocation, in other words, "was generally ignored." On 24 September, PHS announced that it had requested, more specifically, that the vaccine manufacturers fill orders in accordance with state and local priority recommendations, in addition to the population-based system of allocation. Confusion surrounding vaccination priorities plagued even federal agencies. In October,
The Evening Star reported of a "major foul-up" in the provision of vaccine to government employees. The
Civil Service Commission, among some other agencies, had been inoculating any who applied, while others, such as the
Commerce Department, had been giving vaccine only to those deemed "essential", such as air traffic controllers within the
Civil Air Administration. The director of personnel at the Commerce Department, Carlton Hayward, expressed plainly that the process had been "handled sloppily". Hayward's assistant, John S. Myers, suggested two items to improve the allocation policy
—"clearcut guidance" on this issue from PHS and specification as to whether federal agencies could use vaccine funding for those other than essential workers
—noting that doing so could well save money on sick leave. Similar criticisms were echoed across the country, even as the pace of production continued to accelerate. In Boston, city councilors charged that a "lack of leadership" on the part of state and federal health authorities had created a "black market" for the vaccine, with some doctors allegedly charging "exorbitant amounts" for shots. In California, testifying before the subcommittee on intergovernmental affairs in the
State Assembly, Director of the
Department of Public Health Malcolm Merrill expressed his view that insufficient planning had gone into the system of allocation based on state population. Neither were the manufacturers themselves spared of criticism for their part in this vaccine "black market": After the Queens County Medical Society contacted several of the companies to protest their "maldistribution" of vaccine to such nonessential recipients as "banks, candy stores, hair net factories, etc.", the firms reportedly could offer nothing in response but "very evasive answers" and "vague explanations". With flu cases having peaked, and excess mortality at this point increasing, in the latter half of October, PHS announced the development of a more "potent" vaccine to be available by the end of November. Vaccine remained scarce in many places by the end of October, while in others supply had improved. In
Oklahoma City for a water pollution control meeting, Burney provided the expectation that the epidemic would continue for 8 to 10 weeks and recommended that people should take the improved vaccine when it was available but that they should not wait if they were able to take the currently available vaccine. By early November, estimated flu cases had reached 6 million while mortality peaked during the first week of the month. Cities like
Philadelphia and Washington, D.C., continued to urge those not yet inoculated to get the vaccine, at this point, in part, in an effort to ward off a potential second wave. On 8 November, with over 40 million doses released thus far, PHS announced an end to the voluntary allocation program; distributors were now free to send vaccine supplies to areas of high demand rather than attempt an equitable allocation. At the 85th annual meeting of the
American Public Health Association on 14 November, PHS information chief J. Hunter Stewart addressed the vaccine situation, reporting that the time of demand exceeding supply had ended in many places and would soon end in all places across the country. With the epidemic declining in most places by early December, demand for the vaccine began to decline as well, leaving behind a considerable surplus, and manufacturers began to cut back on production. By 11 December, over 54 million doses had been released. Despite improving conditions, Burney urged continued vaccination given the possibility for another, even more severe wave later in the winter, and noted that the estimated 22 million to 25 million doses still on the way would be sufficient to control any new outbreaks until production could restart. Overall, this vaccination effort was considered to be a "gamble". The industry as a whole invested $20 million in production, without any subsidization by the government and with no guarantee, other than assurances from PHS, that there would be demand for the vaccine. Reflecting on lessons learned from this episode, PHS acknowledged after the fact that "a more coherent system of allocation" would be necessary, particularly when demand far exceeds available supply.
Post-pandemic The number of deaths peaked the week ending 17 October, with 600 reported in
England and Wales. Some predicted that the US death toll would have reached 1 million without the vaccine that Hilleman called for. H2N2 influenza virus continued to be transmitted until 1968, when it transformed via
antigenic shift into
influenza A virus subtype H3N2, the cause of the
1968 influenza pandemic. == Virology and clinical data ==